Page 1 of 39
Journal of Neurotrauma Comorbidities: a key issue in patients with disorders of consciousness (doi: 10.1089/neu.2014.3659) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
1 Comorbidities:
a
key
issue
in
patients
with
disorders
of
consciousness
Francesca Pistoia,1 Simona Sacco,1 Marco Franceschini,2 Marco Sarà,3 Caterina
Pistarini,4
Cazzulani,4
Benedetta
Ilaria
Simonelli,5,6
Patrizio Pasqualetti,5,6 Antonio Carolei1
1. Neurological Institute, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy 2. Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy 3. Post-Coma and Rehabilitation Care Unit, Hospital San Raffaele, Cassino, Italy. 4. Post-Coma and Rehabilitation Care Unit, IRCCS Maugeri Foundation, Pavia, Italy. 5. Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, AFaR Division, Rome, Italy 6. Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy
Running title: Comorbidities and disorders of consciousness
Correspondence to: Francesca Pistoia MD Assistant Professor of Neurorehabilitation Neurological
Institute,
Department
Clinical Sciences University of L'Aquila 67100 L'Aquila - Italy Tel and Fax +39.0862.433552 Mobile +39.348.0136406 [email protected]
1
of
Biotechnological
and
Applied
Page 2 of 39
Journal of Neurotrauma Comorbidities: a key issue in patients with disorders of consciousness (doi: 10.1089/neu.2014.3659) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
2
Full mailing address and contact information of coauthors: Simona Sacco: Neurological Institute, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio 67100 L’Aquila, Italy. Tel and Fax +39.0862.433552, [email protected] Marco Franceschini: Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Via della Pisana 235, 00163 Rome, Italy. Tel +39.06.52252402, Fax +39.06.52255683 [email protected] Marco Sarà: Post-Coma and Rehabilitation Care Unit, Hospital San Raffaele, Via Gaetano di Biasio 03043 Cassino, Italy. Tel +39.0776.3941, Fax +39.0776.394403 [email protected] Caterina Pistarini: Post-Coma and Rehabilitation Care Unit, IRCCS Maugeri Foundation, 27100 Pavia, Italy. Tel +39.0382.592637, Fax +39.0382.592080, [email protected] Benedetta Cazzulani: Post-Coma and Rehabilitation Care Unit, IRCCS Maugeri Foundation, 27100 Pavia, Italy. Tel +39.0382.592637, Fax +39.0382.592080, [email protected] Ilaria Simonelli: Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, AFaR Division Lungotevere de' Cenci 5, 00186 Rome, Italy. Tel +39.06.68370511, Fax +39.06.6837360, [email protected] Patrizio Pasqualetti: Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, AFaR Division Lungotevere de' Cenci 5, 00186 Rome, Italy. Tel +39.06.68370511, Fax +39.06.6837360, [email protected] Antonio Carolei: Neurological Institute, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio 67100 L’Aquila, Italy. Tel and Fax +39.0862.433552, [email protected]
2
Page 3 of 39
Journal of Neurotrauma Comorbidities: a key issue in patients with disorders of consciousness (doi: 10.1089/neu.2014.3659) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
3 Abstract The objective of this study was to identify the impact of comorbidities on outcomes of patients with vegetative state (VS) or minimally conscious state (MCS). All patients in VS or MCS consecutively admitted to two Post-Acute Care Units within a 1year period were evaluated at baseline and at 6 months through the Coma Recovery Scale – Revised Version (CRS-R) and the Disability Rating Scale (DRS). Comorbidities were also recorded for each patient along the same period. Six-month outcomes included death, full recovery of consciousness, and functional improvement. One hundred and thirty-nine patients (88 men and 51 women, median age 59 years) were included. Ninety-seven patients were in VS (70%) and 42 in MCS (30%). At 6 months, 33 patients were dead (24%), 39 had a full recovery of consciousness (28%) and 67 remained in VS or MCS (48%). According to DRS scores, 40% of patients (n=55) showed a functional improvement in the level of disability. One hundred and thirty patients (94%) showed at least one comorbidity. Severity of comorbidities (HR=2.8, 95% CI 1.71-4.68; p0.20) but it was related to baseline CRS-R score (Spearman rho -0.28, p=0.001) and to age (Spearman's rho 0.47, p
Journal of Neurotrauma Comorbidities: a key issue in patients with disorders of consciousness (doi: 10.1089/neu.2014.3659) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
1 Comorbidities:
a
key
issue
in
patients
with
disorders
of
consciousness
Francesca Pistoia,1 Simona Sacco,1 Marco Franceschini,2 Marco Sarà,3 Caterina
Pistarini,4
Cazzulani,4
Benedetta
Ilaria
Simonelli,5,6
Patrizio Pasqualetti,5,6 Antonio Carolei1
1. Neurological Institute, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy 2. Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy 3. Post-Coma and Rehabilitation Care Unit, Hospital San Raffaele, Cassino, Italy. 4. Post-Coma and Rehabilitation Care Unit, IRCCS Maugeri Foundation, Pavia, Italy. 5. Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, AFaR Division, Rome, Italy 6. Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy
Running title: Comorbidities and disorders of consciousness
Correspondence to: Francesca Pistoia MD Assistant Professor of Neurorehabilitation Neurological
Institute,
Department
Clinical Sciences University of L'Aquila 67100 L'Aquila - Italy Tel and Fax +39.0862.433552 Mobile +39.348.0136406 [email protected]
1
of
Biotechnological
and
Applied
Page 2 of 39
Journal of Neurotrauma Comorbidities: a key issue in patients with disorders of consciousness (doi: 10.1089/neu.2014.3659) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
2
Full mailing address and contact information of coauthors: Simona Sacco: Neurological Institute, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio 67100 L’Aquila, Italy. Tel and Fax +39.0862.433552, [email protected] Marco Franceschini: Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Via della Pisana 235, 00163 Rome, Italy. Tel +39.06.52252402, Fax +39.06.52255683 [email protected] Marco Sarà: Post-Coma and Rehabilitation Care Unit, Hospital San Raffaele, Via Gaetano di Biasio 03043 Cassino, Italy. Tel +39.0776.3941, Fax +39.0776.394403 [email protected] Caterina Pistarini: Post-Coma and Rehabilitation Care Unit, IRCCS Maugeri Foundation, 27100 Pavia, Italy. Tel +39.0382.592637, Fax +39.0382.592080, [email protected] Benedetta Cazzulani: Post-Coma and Rehabilitation Care Unit, IRCCS Maugeri Foundation, 27100 Pavia, Italy. Tel +39.0382.592637, Fax +39.0382.592080, [email protected] Ilaria Simonelli: Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, AFaR Division Lungotevere de' Cenci 5, 00186 Rome, Italy. Tel +39.06.68370511, Fax +39.06.6837360, [email protected] Patrizio Pasqualetti: Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, AFaR Division Lungotevere de' Cenci 5, 00186 Rome, Italy. Tel +39.06.68370511, Fax +39.06.6837360, [email protected] Antonio Carolei: Neurological Institute, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio 67100 L’Aquila, Italy. Tel and Fax +39.0862.433552, [email protected]
2
Page 3 of 39
Journal of Neurotrauma Comorbidities: a key issue in patients with disorders of consciousness (doi: 10.1089/neu.2014.3659) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
3 Abstract The objective of this study was to identify the impact of comorbidities on outcomes of patients with vegetative state (VS) or minimally conscious state (MCS). All patients in VS or MCS consecutively admitted to two Post-Acute Care Units within a 1year period were evaluated at baseline and at 6 months through the Coma Recovery Scale – Revised Version (CRS-R) and the Disability Rating Scale (DRS). Comorbidities were also recorded for each patient along the same period. Six-month outcomes included death, full recovery of consciousness, and functional improvement. One hundred and thirty-nine patients (88 men and 51 women, median age 59 years) were included. Ninety-seven patients were in VS (70%) and 42 in MCS (30%). At 6 months, 33 patients were dead (24%), 39 had a full recovery of consciousness (28%) and 67 remained in VS or MCS (48%). According to DRS scores, 40% of patients (n=55) showed a functional improvement in the level of disability. One hundred and thirty patients (94%) showed at least one comorbidity. Severity of comorbidities (HR=2.8, 95% CI 1.71-4.68; p0.20) but it was related to baseline CRS-R score (Spearman rho -0.28, p=0.001) and to age (Spearman's rho 0.47, p
